MEDICARE: THERESE M SHUMAKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	1919	MN
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1205806916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESE M SHUMAKER

Provider Business Mailing Address
First Line	:	927 25TH ST SE
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55904-2911
Country	:	US
Telephone Number	:	507-258-3733
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 1ST AVE NW STE 210
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55901-2830
Country	:	US
Telephone Number	:	507-358-3733
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	04/29/2023

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